Case Manager - Talent Pool

Joint Medical Holdings; KwaZulu-Natal; On-site; ZAR 30,000 - 50,000; Full time

Job summary

A leading company in the healthcare sector is seeking a clinical manager responsible for risk management, accurate coding, and ensuring compliance with service level agreements. The role requires strong billing and auditing experience, alongside proficiency in ICD 10 coding in a multidisciplinary environment.

Qualifications

• Must have billing/auditing experience essential.
• Experience in a multidisciplinary hospital environment.
• Experience in liaising with medical aids, doctors and patients.

Responsibilities

• Manage risk through application of clinical knowledge and best operating procedures.
• Ensure accurate and complete ICD 10/CCSA coding.
• Manage internal DSO and ensure optimization of tools used.

Skills

Computer literacy

Billing experience

Auditing experience

ICD 10 coding

CCSA coding

Education

Registration with the SANC as a RN / EN

Job description

PURPOSE OF POSITION

The incumbent will be responsible for managing risk through application of clinical knowledge, best operating procedures, service level agreements and accurate coding. EQUITY REQUIREMENTS Preference will be given to African males or females. KEY PERFORMANCE AREAS

Following the JMH policy with regards to clinical updating within turnaround times and service level agreements.

Accurate and complete ICD 10/ CCSA coding.

Month end deadlines.

Ensure accurate and complete billing.

Ensure adequate and appropriate information is communicated about the medical schemes.

To manage the internal DSO and ensure optimization of tools used.

Ensure complete rollout and compliance of Care Risk Management Procedures and Protocols.

Ensure effective resolution to rejections relating to case management. COMPETENCIES (The following will be advantageous)

Minimum Requirements

(Educational Qualifications & Experience)

Registration with the SANC as a RN / EN.

Must be computer literate.

Must Have Billing / Auditing Experience Essential.

Experience in a multidisciplinary hospital environment.

ICD 10 And CCSA Coding Experience Is Required.

Must have experience in liaising with medical aids, doctors and patients.